(65) Percutaneous Image-Guided Cryoablation of Recurrent Myxofibrosarcoma in the Forearm

Jason Manaparambil, MD – Interventional Radiology Fellow, Division of Vascular and Interventional Radiology, Mayo Clinic; Indravadan Patel, MD – Interventional Radiologist, Division of Vascular and Interventional Radiology, Mayo Clinic

Purpose: To demonstrate the effectiveness of image-guided cryoablation for treatment of recurrent myxofibrosarcoma (MFS) in an anatomically complex location, particularly in a patient with previous surgical and radiation therapy.

Material and Methods: An 81-year-old male with a history of recurrent MFS in the left forearm, previously treated with surgery and radiation, underwent percutaneous cryoablation guided by real-time ultrasound and computed tomography (CT). Two cryoprobes were inserted along the long-axis, targeting a lesion within the supinator muscle belly. A double freeze-thaw cycle was used to achieve a 5 mm ablation margin. Skin protection was implemented using warm saline gloves. Intra-procedural CT imaging confirmed ice ball formation and monitored coverage.

Results: Post-operative MRI at 9 months showed no significant enhancement of the treated lesion, suggesting no residual tumor. The use of intra-procedural imaging indicated no significant hemorrhage or other adverse events during the procedure while achieving an adequate zone of ablation for complete tumor necrosis. To mitigate risks of skin necrosis and nerve injury, precautionary techniques were used, including thermal protection and probe placement maintaining >5 mm from the skin and >3 mm from neurovascular structures.

Conclusions: This case underscores the technically successful utility of cryoablation for the clinical management of a soft tissue myxofibrosarcoma. Cryoablation offers a potential minimally invasive intervention for adequate localization of the tumor while preserving adjacent critical anatomical structures. This case further emphasizes the potential of cryoablation to be used for soft tissue sarcomas over conventional surgical methods in surgical beds with recurrent disease.